Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms(LUTS). In this review, we summarise the conclusions from fourof the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life(Qo L) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and Qo L available to men with LUTS. Metaanalyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.

Evaluation of the Quality of Prenatal Consultation in Rural Area of Mali, Case of Kadiolo Health District

Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.

Determinants of the Frequency of Prenatal Consultations among Women Giving Birth in the Maternity Wards of the Commune of Agbangnizoun (Zou), Benin

Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal clinics as recommended by the WHO. The general objective of this study was to study the norm in terms of Antenatal Consultation (ANC) frequency as well as the determinants of the frequency among women who gave birth in the maternity hospitals of Agbangnizoun. Our research was a cross-sectional, descriptive, retrospective and quantitative type, which was carried out among 335 women in Agbangnizoun, Benin from 1 February to 3 April 2020 (3 months), in order to find out the general or specific characteristics of women that we associate with the frequency of prenatal consultation. At the end of the study, we found that 60%, 68% and 15% of the surveyed population had received ANC in the first, second and third trimesters, respectively. Ethnicity, income level of spouses over the three trimesters as well as the level of their knowledge and overall practice of ANC are determinants of the frequency of prenatal consultation.

Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

Use of Analogy by Public Health Nurses in Problem Solving for Individual Consultations in Japan: A Multiple Case Study

Aim: Nurses must develop good problem-solving skills (PSS) to work in the complex health care environment. This study explored PHNs’ use of analogy in PSS development. The purposes of the study were to clarify how PSS developed in one area (i.e., mental health) could be applied to another area (i.e., maternal health) and whether new PSS could develop in response to PSS gained in another area. Methods: A multiple case study was conducted using interviews. We interviewed 27 consultations from eight Japanese PHNs who consulted in mental health departments before transferring to maternal health departments. The data on how PHNs applied PSS in the selection, mapping, evaluation, and learning stages of the analogy process were extracted from transcribed interviewed data and compared. Results: PHNs provided 59 PSS used in 27 consultations. All PHNs applied past mental health PSS to solve new problems in maternal health. They tended to select past PSS based on structural similarity and to apply PSS via low-level abstraction in serious situations or preventively to avoid causing the current situation to worsen. Notably, PHNs developed maternal health PSS by using past mental health PSS;these new PSS were derived through analogy from various failures and successes. Conclusions: PSS developed in one area can be applied in another area, and new PSS can develop through applying these previous PSS. Identification of structural similarities and preventive analogies must be included in nursing education, especially for nurses working in public health fields.

Epidemiological Profile of Diagnosed Disorders in Urological Consultation at Sylvanus Olympio Teaching Hospital in Lome

Context: Thanks to the increase in the number of urologists in Togo, urological activity is improving rapidly. Objective: This study aims at presenting the epidemiological aspects of the diseases diagnosed in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome. Materials and Methods: This research was a two-year retrospective and descriptive study. The data for the analysis were collected from the records of patients received in consultation for urological pathology. The parameters taken into account are: frequency, age, sex, occupation, patient history and diagnosis. Results: 602 patients were admitted at the department of urology within two years, with an annual frequency of 301. The average age of the patients was 48.63 ± 19.69 years;the sex ratio (M/F) was equal to 12.08. Patients over 60 years of age accounted for 33.3% of the patients seen. The medical history of 88 cases showed that the bladder catheterization was most frequent (22 cases) followed by hypertension (15 cases). Benign prostatic hyperplasia was the most frequently diagnosed pathology accounting for 24.9% of the consultations. Conclusion: Benign prostatic hyperplasia is the most frequent pathology in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome.

Patient Education Level and Utilization of Internet Resources by Patients in Orthopedic Hip and Knee Consultations

Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available online written from various sources and perspectives. However, the role of internet and its impact on patient’s care and understanding of the disease remains unclear. The purpose of this study is to evaluate the role and effect of internet use for patients seeking consultation for hip and knee arthritis. More specifically, the relationship between patient’s education level, internet use, motives for doing background readings, perception of internet information, and reactions to the available information will be studied. Method: Patients seeking orthopaedic consultation for knee or hip arthritis at the Toronto Western Hospital were identified and invited to fill out a questionnaire on their first visit. The questionnaire was designed to assess the patients’ pre-consultation reading habits, their use of internet, and their reaction to what they have read on the internet. The questionnaire also included questions about the respondent’s background.Results: In comparing patients holding college/university degree (CU) with patients having no college/university education (NoCU), the CU group were associated with increased internet use (CU vs. NoCU: 71.0% vs. 48.3%;p 0.01) and background reading (CU vs. NoCU: 82.2% vs. 17.8%;p 0.001) prior to consultation;fewer incidence of anxiety following internet use (CU vs. NoCU: 29.9% vs. 53.6%;p 0.05);and higher rates of decisions influenced by internet use (CU vs. NoCU: 20.8% vs. 3.6%, p 0.05). Internet users demonstrated a higher confidence in gathering and understanding medical information (Internet users vs. non-internet users: 6.59 ± 2.05 vs. 5.03 ± 2.78;p 0.001) and rated the accuracy of information on internet at 7.18 ± 2.01 (max = 10). Conclusion: Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.

Hello,can you hear me?Orthopaedic clinic telephone consultations in the COVID-19 era-a patient and clinician perspective

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

Public Consultation of International Cosmetics Standard Chinese Name Directory(2018 Version) by the State Drug Administration

On 7 September, 2018, the International Cosmetic Ingredient Dictionary and Handbook (2016 Sixteenth Edition) published by Personal Care Products Council, U.S., was translated by the China Food and Drug Administration in order to further manage registration and record-keeping of cosmetics. The International Cosmetics Standard Chinese Name Directory (2018 version) was then generated and asked for public consultation. Enterprises and individuals may give their feedback and opinions to China Food and Drug Administration in the form of E-mail before 10 October, 2018.

Physicians’Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.

First Consultation in Nephrology: Case of the Point G University Hospital (Bamako-Mali)

Understanding the first consultation of people with kidney disease seems to us to be essential to understand the attitude of the referring physician and the nephrologist. The aim was to find out to whom a patient with kidney disease should be referred in the first instance and for what reason? Hence the evaluation of the prevalence of the first consultation in the nephrology department of the Point G University Hospital in Bamako was made. Patients and Method: This was a prospective descriptive study which took place from July 2017 to June 2018 in the nephrology department of the Point G University Hospital. The study included all patients who came to the nephrology department for the first time during this period. Results: Between July 2017 and June 2018 at the nephrology and haemodialysis service of the G point University Hospital, we retained 643 out of 1031 patients who came for their first consultation, i.e. 62.36%. There were many patients aged between 41 and 50 years. The average age was 42.6 ± 5.03 years with extremes of 30 and 82 years. The sex ratio (M/F) was in favor of males, 1.14. The majority of patients were referred/evacuated from the referral health centres (57.6%). The majority of patients were referred/evacuated by general practitioners (70.5%). Cardiologists were the main specialists to refer/evacuate patients (21.2%). The main reasons for consultation that led to the first diagnostic hypotheses were: arterial hypertension for vascular nephropathy, glomerular syndrome for glomerular nephropathy, acute uraemia syndrome for acute renal failure, hydronephrosis for obstructive uropathy and finally diabetes for diabetic nephropathy. Conclusion: The first consultation in nephrology remains an important step in the management of renal disease, especially when the referral is an emergency. The percentage of referrals is dominated by general practitioners.

Annual Consultation on the Likelihood of Earthquakes in Continental China: Its Scientific and Practical Merits

Since the 1970s, Chinese seismologists have started to conduct the Annual Consultation on the Likelihood of Coming Earthquakes in the Next Year. This approach has unique scientific and practical merits either as an active response to the social needs in the situation that earthquake prediction research meets many difficulties, or as a real forward prediction test persistently conducted for 1/3 century. It is a pity that such an approach has not been well-known by international seismological community, and the scientific merits of such an endeavor is sometimes regrettably underestimated.

Epidemiological and Clinical Profile of Patients Undergoing Primary Nephrological Consultation at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.

TdBrnn:An Approach to Learning Users’Intention to Legal Consultation with Normalized Tensor Decomposition and Bi-LSTM

With the development of Internet technology and the enhancement of people’s concept of the rule of law,online legal consultation has become an important means for the general public to conduct legal consultation.However,different people have different language expressions and legal professional backgrounds.This phenomenon may lead to the phenomenon of different descriptions of the same legal consultation.How to accurately understand the true intentions behind different users’legal consulting statements is an important issue that needs to be solved urgently in the field of legal consulting services.Traditional intent understanding algorithms rely heavily on the lexical and semantic information between the original data,and are not scalable,and often require taxing manual annotation work.This article proposes a new approach TdBrnn which is based on the normalized tensor decomposition method and Bi-LSTM to learn users’intention to legal consulting.First,we present the users’legal consulting statements as a tensor.And then we use the normalized tensor decomposition layer proposed by this article to extract the tensor elements and structural information of the original tensor which can best represent users’intention of legal consultation,namely the core tensor.The core tensor relies less on the lexical and semantic information of the original users’legal consulting statements data,it reduces the dimension of the original tensor,and greatly reduces the computational complexity of the subsequent Bi-LSTM algorithm.Furthermore,we use a large number of core tensors obtained by the tensor decomposition layer with users’legal consulting statements tensors as inputs to continuously train Bi-LSTM,and finally derive the users’legal consultation intention classification model which can comprehensively understand the user’s legal consultation intention.Experiments show that our method has faster convergence speed and higher accuracy than traditional recurrent neural networks.

Function of Management Consultation in Implementation of ERP Project

ERP(enterprise resource planning) is a huge and com pl ex system engineering which costs a great lot of fund and manpower. It is a refo rm in the enterprise management mode, management idea and management method whi ch needs mass fund import, with long period, full of risk, hard to perform and can’t show its effects at once. The essence of the enterprise performing in ERP system is to run a "management engineering", which involves integration of opera tion process. The integration will touch business culture, enterprise system,m eans of operation and the department’s regulatioins amongst the operation conten ts, rights and responsibilities. Totally, the ERP system is the rebuilding of ma ngagement idea, method and means, which needs the common acquaintance from the t op management to the whole stuff.Meantime, it requires a perfect tactic to perfo rm an ERP system. We must confirm a cut-in spot as the right space to start bas ed on the enterprise requirement and the application environment. And to choose a right space decides that the application of ERP system is successful or not. S o, we must make it clear to build which subsystem first, to take the right seque nce for performing all kinds of function modules and the final integrated functi ons . All this prepared work for the implement of ERP system and the management, the recombination and optimization of enterprise management operation flow, ite m management and harmonization, ERP educational training and so on can not be pe rformed well without management consultancy. The effective management consultan cy can lead then implement of ERP system to shorten the executive cycle, to quik en the realization of effect and to harmonize the relationship to the client ent erprises so that to ensure the successful perform of ERP.

Modeling and Simulation Study of Space Data Link Protocol

This research paper describes the design and implementation of the Consultative Committee for Space Data Systems (CCSDS) standards REF _Ref401069962 \r \h \* MERGEFORMAT [1] for Space Data Link Layer Protocol (SDLP). The primer focus is the telecommand (TC) part of the standard. The implementation of the standard was in the form of DLL functions using C++ programming language. The second objective of this paper was to use the DLL functions with OMNeT++ simulating environment to create a simulator in order to analyze the mean end-to-end Packet Delay, maximum achievable application layer throughput for a given fixed link capacity and normalized protocol overhead, defined as the total number of bytes transmitted on the link in a given period of time (e.g. per second) divided by the number of bytes of application data received at the application layer model data sink. In addition, the DLL was also integrated with Ground Support Equipment Operating System (GSEOS), a software system for space instruments and small spacecrafts especially suited for low budget missions. The SDLP is designed for rapid test system design and high flexibility for changing telemetry and command requirements. GSEOS can be seamlessly moved from EM/FM development (bench testing) to flight operations. It features the Python programming language as a configuration/scripting tool and can easily be extended to accommodate custom hardware interfaces. This paper also shows the results of the simulations and its analysis.

Estimation of Costs-Savings and Improved Patient Outcomes of Implementing a Consultation-Liaison Service at Health Sciences North

Objective: The study was conducted to assess the implementation of a psychiatric consultation-liaison service (C-L) from the perspective of cost-savings, staff satisfaction, patient satisfaction and to assess the general features of patients referred to the C-L service. Methodology: Cost-savings were evaluated using a large cohort of referrals to the hospital were identified using data derived from the Institute of Clinical Evaluative Sciences (N = 2246);these data were divided into pre and post periods with respect to imitation of the C-L service. To evaluate staff satisfaction, 170 nurses and physicians completed an online survey. Patient satisfaction was assessed through a survey assessing various aspects of their experiences with the C-L service that was completed by each patient (N = 40). Finally referrals to the C-L service (N = 445) were analyzed to discern indicators of the C-L service’s efficacy (i.e. reasons for referral, time to accommodate referral). Results: The data indicated: 1) a reduction in the number of re-admissions and length of stay after the initiation of the C-L service translating into significant cost-savings for the hospital, 2) that increased staff satisfaction was associated with providing confidence, support, and improved communication, and 3) that the C-L service accommodated approximately 90% of patients within 1 day. Conclusion: The results of this study support stakeholders’ decisions to implement C-L services and also indicate areas of improvement that may improve the quality of C-L services within other institutions.